Treating Doctors the Way We Treat Teachers (Part Two)

A post I wrote a few weeks ago about treating doctors like we do teachers generated, at least in my little world, a lot of buzz. I enjoyed both the critique of my analogies and those who challenged me to take them further. I have a couple of things to say as I continue this conversation.

First and foremost, I want to make it clear that an air of sarcasm enveloped the piece. I'm familiar with the accountability measures imposed upon doctors and the inherent unreasonableness of comparing the quality of physicians to the crude quantitative thresholds --- like BMI or cholesterol -- of their patients. In highlighting the absurd connotations of evaluating and, subsequently, remunerating doctors based on the annual health of all of their patients, I hoped to identify how absurd it's to hold teachers accountable to scores on a single standardized test. We've known for quite some time that external factors, from family income to the numbers of books in a student's household, can affect performance on state tests. Teachers do add value to student achievement and figuring that out is worth future study. However, narrowing all decision-making to that specific value places an unfairly excessive importance on a phenomenon not entirely under the teacher's control.

The second item on the agenda here is to take my previous doctor-teacher analogy and double down. That's right. In order for the United States to remain economically competitive and "win our future," so to speak, we must ensure that we have and maintain a healthy workforce. The American people cannot be as innovative or productive if they are sick. The challenge then is for the medical profession to pony up and guarantee that our people are ready to work out and work hard.

We have a health care crisis in this nation, both in terms of cost and outcomes. According to a recent report from the CDC, the United States devotes more of its gross domestic product to health care than any other industrialized country, with an average per capita spending in 2007 totaling $7,200. What are we getting from that? It seems like a whole lot of nothing. Although life expectancy at birth increased between 1990 and 2007, it still remains one of the lowest of 37 industrialized countries and territories. Obesity rates, which can lead to numerous other health risks, more than doubled in both school-age children and adults.

Our health care crisis is magnified in our cities and with minority populations, something of which we should be ashamed. For example, the mortality rate for African-Americans is 25 percent higher and the death rates for numerous conditions -- such as diabetes, stroke, heart disease, cancer and HIV -- are also more pronounced. The death rate for HIV alone is 786 percent higher for black Americans, which is extremely tragic. I could continue citing the negative disparities in the health statistics from access to health care services to rates of disability. So I ask this with both a sarcastic tone -- in light of my analogy between doctors and teachers -- and with real outrage: How can the medical profession be failing so miserably in improving the health outcomes of certain populations?

Perhaps only two conclusions can be drawn: that doctors are either glaringly incompetent or they are not putting the needs of patients first.

Rather than helping the people who need medical care the most, are many of our best and brightest doctors going into advanced specialties of which the urban poor cannot gain access? Are they instead making more money injecting fat in affluent cheeks than figuring out how to lower dramatically-increased diabetes rates in urban areas? People without jobs cannot find work if they are sick. Those who are more likely to be unemployed might be the ones that seem to be at higher risk of various illnesses. Without a job, they're also without access to health care, which could worsen their overall health.

The race to the top will be slow and sweaty if we cannot improve the health of our workforce.

As a result, rather than simply measuring the outcomes of all a given physician's patients to determine quality of care, maybe it's time to break patients down into racial, income and gender subgroups. Perhaps then physicians will pay more attention to their patients with greatest need and risk. The data confirms that the medical profession is failing our entire population and it's also failing our most underprivileged.